Post-Traumatic Stress Disorder

Topic Overview

What is PTSD?

Post-traumatic stress disorder (PTSD) can occur after you have been through a traumatic event.
A traumatic event is something horrible and scary that you see or that happens
to you. During this type of event, you think that your life or others' lives
are in danger. You may feel afraid or feel that you have no control over what
is happening.

Anyone who has gone through a life-threatening
event can develop PTSD. These events can include:

Combat

Military sexual trauma.

Terrorist
attacks.

Physical violence.

Sexual violence, such as rape.

Serious accidents, such as a car wreck.

Natural
disasters, such as a fire, tornado, flood, or earthquake.

After the event, you may feel scared, confused, and
angry. If these feelings don't go away or they get worse, you may have PTSD.
These symptoms may disrupt your life, making it hard to continue with your
daily activities.

What are the symptoms?

After going through a
traumatic event, you may:

Feel upset by things that remind you of what
happened.

Have nightmares, vivid memories, or flashbacks of the
event. You may feel like it's happening all over again.

Avoid
places or things that remind you of what happened.

Feel numb or
lose interest in things you used to care about.

Feel that you are
always in danger.

Feel anxious, jittery, or irritated.

Have trouble sleeping or keeping your mind on one thing.

PTSD symptoms can change your behavior and how you live
your life. You may pull away from other people, work all the time, or
use drugs or alcohol. You may find it hard to be in
relationships, and you may have problems with your spouse and family. You may
become
depressed. Some people with PTSD also have
panic attacks, which are sudden feelings of fear or
worry that something bad is about to happen.

Children can have
PTSD too. They may have the symptoms above and symptoms that depend on how old
they are. As children get older their symptoms are more like those of
adults.

Young children may become upset if their
parents are not close by. Or children may have trouble sleeping or suddenly have trouble with
toilet training or going to the bathroom.

Children who are in the first few years of elementary school
(ages 6 to 9) may act out the trauma through play, drawings, or stories. They
may complain of physical problems or become more irritable or aggressive. They
also may develop fears and anxiety that don't seem to be caused by the
traumatic event.

What can you do if you think you have PTSD?

If you think
you have PTSD, it's important to get treatment. Treatment can work, and early
treatment may help reduce long-term symptoms.1, 2

If you think you have PTSD:

Talk to your family doctor.

Talk
to a mental health professional, such as a therapist.

If you're a
veteran, contact your local VA hospital or Vet Center.

Talk to a
close friend or family member. He or she may be able to support you and find
you help.

If you have thoughts about hurting yourself or someone else, call 911, 1-800-273-TALK (suicide hotline), or go to a hospital emergency room.

How does PTSD develop?

All people with PTSD have
personally experienced—or have experienced through others—a traumatic event that caused them to fear for their lives, see
horrible things, and feel helpless. Strong emotions caused by the event create
changes in the brain that may result in PTSD.3

Many people who go through a traumatic event don't get PTSD. It isn't
clear why some people develop PTSD and others don't. How likely you are to get
PTSD depends on many things. These include:

How intense the trauma was.

If
you lost a loved one or were hurt.

How close you were to the
event.

How strong your reaction was.

How much you felt
in control of events.

How much help and support you got after the
event.

PTSD symptoms usually start soon after the traumatic
event, but they may not happen until months or years later. They also may come
and go over many years. About half of people who develop PTSD get
better at some time. But other people who
develop PTSD always will have some symptoms.4

If you have symptoms of PTSD, counseling can help you cope. Your symptoms
don't have to interfere with your everyday activities, work, and relationships.
It is never too late to get professional help or other forms of support that
can help you manage the symptoms of PTSD.

Reminders and
anniversaries of the event can make symptoms worse.

How is PTSD treated?

Counseling, which can help you understand your thoughts
and learn ways to cope with your feelings. This can help you feel more in
control and get you back to the activities in your life. A type of counseling
called cognitive-behavioral therapy has been shown to be the most effective
form of counseling for PTSD.1, 2

Antidepressant medicines,
especially selective serotonin reuptake inhibitors (SSRIs). These can help you
feel less sad and worried. SSRIs include fluoxetine (such
as Prozac), paroxetine (Paxil), and sertraline (Zoloft).

You may need to try different types of treatment before
finding the one that helps you. Your doctor will help you with this. These
treatments may include other types of medicines and other forms of counseling,
such as
group counseling. If you have other problems along
with PTSD, such as overuse of alcohol or drugs, you may need treatment for
those also.

Treatment can help you feel more in control of your
emotions, have fewer symptoms, and enjoy life again.

One Man's Story:

"I can't turn my brain off.
Sometimes I stay up all night. The bad part is not staying up, but what's going
through my head. I can't stop it."—Marvin

Symptoms

Symptoms of
post-traumatic stress disorder (PTSD) can be
terrifying. They may disrupt your life and make it hard to continue with your
daily activities. It may be hard just to get through the day.

PTSD
symptoms usually start soon after the traumatic event, but they may not happen
until months or years later. They also may come and go over many years. If the
symptoms last longer than 4 weeks, cause you great distress, or interfere with
your work or home life, you may have PTSD.

Even if you
always have some symptoms, counseling can help you cope. Your symptoms don't
have to interfere with your everyday activities, work, and relationships.

Most people who go through a traumatic event have some symptoms
at the beginning but don't develop PTSD.

There are four types of
symptoms:

Reliving the event

Bad memories of the traumatic event can come back at any time. You may
feel the same fear and horror you did when the event took place. You may feel
like you're going through the event again. This is called a flashback.
Sometimes there is a trigger: a sound or sight that causes you to relive the
event. Triggers might include:

Hearing a car backfire, which can bring back
memories of gunfire and war for a combat veteran.

Seeing a car
accident, which can remind a crash survivor of his or her own
accident.

Seeing a news report of a sexual assault, which may bring
back memories of assault for a woman who was raped.

Avoiding situations that remind you of the event

You may try to avoid situations or people that
trigger memories of the traumatic event. You may even avoid talking or thinking
about the event.

A person who was in an earthquake may avoid
watching television shows or movies in which there are
earthquakes.

A person who was robbed at gunpoint while ordering at
a hamburger drive-in may avoid fast-food restaurants.

Some people
may keep very busy or avoid seeking help. This keeps them from having to think
or talk about the event.

Feeling numb

You may
find it hard to express your feelings. This is another way to avoid
memories.

You may not have positive or loving feelings
toward other people and may stay away from relationships.

You may
not be interested in activities that you enjoyed in the past.

You may forget
about parts of the traumatic event or not be able to talk about them.

Feeling keyed up

You
may be alert and on the lookout for danger. This is known as increased
emotional arousal. It can cause you to:

Suddenly become angry or
irritable.

Have a hard time sleeping.

Have trouble
concentrating.

Fear for your safety and always feel on
guard.

Be very startled when someone surprises you.

Other symptoms

Other symptoms also may
include:

Physical symptoms for no reason you can think
of (called somatic complaints).

Feelings of shame, despair, or
hopelessness.

Difficulty controlling your
emotions.

Problems with family or friends.

Impulsive or
self-destructive behavior.

Changed beliefs or changed personality
traits.

One Man's Story:

"People don't understand the
emotion tied to flashbacks. It's like it's happening all over again, and you're
having the same physiological reactions."— Marvin

PTSD in children and teens

Children can have PTSD
too. They may have the symptoms listed above and/or symptoms that depend on how
old they are. As children get older, their symptoms are more like those of
adults.

Young children may become upset if their
parents are not close by. Or children may have trouble sleeping or suddenly have trouble with
toilet training or going to the bathroom.

Children who are in the first few years of elementary school
(ages 6 to 9) may act out the trauma through play, drawings, or stories. They
may complain of physical problems or become more irritable or aggressive. They
also may have fears and anxiety that don't seem to be caused by the traumatic
event.

If you think you or a loved one has symptoms of PTSD, see your doctor right away.
Fill out this form(What is a PDF document?) and take it to your doctor. Treatment can work, and early
treatment may help reduce long-term symptoms.2

Military Concerns

If you were in the military, you
may have seen combat. You may have been on missions that exposed you to
horrible and life-threatening experiences. You may have been shot at, seen a
buddy shot, or seen death. These are types of events that can lead to
post-traumatic stress disorder (PTSD).

Other things about a combat situation can add more stress to
an already stressful situation and may contribute to PTSD and other mental
health problems.7 These
things include what you do in the war, the politics around the war, where it's
fought, and the type of enemy you face.

Another cause of PTSD in the military can be
military sexual trauma (MST). This is any sexual
harassment or sexual assault that occurs while you are in the military. MST can
happen to men and women and can occur during peacetime, training, or war.

Getting treatment

Many veterans don't seek
treatment for PTSD. You may feel that treatment won't help, or worry about what
people will think. Your military background may add other pressures that keep
you from seeking treatment. You may feel that it will hurt your career, or that
those in your unit will lose faith in you. You may fear that your unit will see
you as weak.

If you need help deciding to see your doctor,
see some reasons why people don't get help and ways to overcome them.

The U.S. Department of Veterans Affairs (VA) has many programs
for veterans and their families who are worried about PTSD or related problems.
If you are a veteran, contact your local VA about these resources (http://www.ptsd.va.gov/public/where-to-get-help.asp). You can find
help with treatment, jobs, housing, and sexual assault.

One Man's Story:

"Being in the Guard now is like a
mandatory support group, because they've all been there too."—Tim

Treatment

There are many types of treatment for
post-traumatic stress disorder (PTSD). You and your
doctor will discuss the best treatment for you. You may have to try a number of
treatments before you find one that works for you.

A type of
counseling called cognitive-behavioral therapy and medicines known as SSRIs
appear to be the most effective treatments for PTSD.2
Treatment can help you feel more in control of your emotions and result in
fewer symptoms, but you may still have some bad memories.

Counseling means talking with a therapist on your own or in a group about the
traumatic event and PTSD. You will talk with your therapist about your memories
and feelings. This will help you change how you think about your trauma. You
will learn how to deal with painful feelings and memories, so you can feel
better.

Counseling

There are different types of
counseling for PTSD. Several types of therapy have been shown to be effective in treating PTSD. These therapies are:

Cognitive therapy, in which you learn to
change thoughts about the trauma that are not true or that cause you stress.

Exposure therapy, in
which you talk about the traumatic event over and over, in a safe place, until
you have less fear.

Eye movement desensitization and reprocessing (EMDR), in which you focus on distractions like hand
movements and sounds while talking about the traumatic event.

Finding a therapist you trust is important. A good
therapist will listen to your concerns and help you make changes in your life.
Your doctor can help you find one. If you are a veteran, the VA is a good place
to start. Churches sometimes offer services that help people get counseling. Or
you can call your state Health and Welfare office.

SSRI medicine

SSRIs (selective serotonin reuptake inhibitors) are a type of antidepressant medicine. These can
help you feel less sad and worried. They appear to be helpful, and for some
people they are very effective. SSRIs include fluoxetine
(such as Prozac), paroxetine (Paxil), and sertraline (Zoloft).

One Man's Story:

"It's hard to let people in on
your private thoughts. A professional is a great listener, and if you can let
them in, when you talk about your flashbacks, they understand that they're not
some random thoughts."—Marvin, 58

If you are using medicine, take it exactly as prescribed.
Call your doctor if it's not helping your symptoms or if the side effects are
very bad. You and your doctor will decide what to do.

Deciding to get treatment

Unfortunately, many
people don't seek treatment for PTSD. You may not seek treatment because you
think the symptoms are not bad enough or that you can work things out on your
own. But getting treatment is important.

Treatment can make your
symptoms less intense and stop them from coming back. It can help you connect
with your family, friends, and community. Many people get better with
treatment.

If you need help deciding whether to see your doctor,
see some reasons why people don't get help and ways to overcome them.

When you first see your therapist,
he or she will ask questions about the traumatic event causing PTSD and how
severe your symptoms are. You may want your spouse, your partner, or a close
family member to come with you. This person can help your doctor understand
your symptoms and can help your therapist understand what you've been going
through. Being with someone you trust helps you relax.

If you have
other problems along with PTSD, such as overuse of alcohol or drugs, you also
may need treatment for those problems.

Recovery

Recovery from PTSD does not mean forgetting the past trauma. It does mean that you learn how to not have the bad physical and emotional reactions in response to memories so that you can fully live your life. Recovery is not a cure. It helps you
believe that you can reach your goals and learn new things to help yourself. It
helps you gain self-confidence and respect for yourself.

The
10 principles of recovery(What is a PDF document?) make you the most important part of your recovery. Your
counselor, doctor, family, and medicines can help you, but you're the one who
makes the decisions. In the recovery process, you learn to cope with your
symptoms and challenges and to develop social support.

Positive coping skills

Coping is about dealing
with your symptoms. When you cope with your symptoms in a positive way, you
often feel more in control. You accept what the traumatic event did and take
steps to improve your life.

Exercise and be active to reduce how tense you feel.
People who are fit usually have less anxiety, depression, and stress than
people who aren't active.9

Get enough sleep to help your mood and make you feel less stressed. Many people
with PTSD have trouble sleeping because they feel nervous and anxious or can't
stop thinking about the traumatic event.

Eat a balanced diet to help your body deal with tension and stress. Whole
grains, dairy products, fruits, vegetables, and protein are part of a balanced
diet.

Find things to do to ease your memories and reactions.
Consider channeling your emotions into activities or sports, painting or
writing, or a rewarding job.

Identify your beliefs to keep you balanced. PTSD can cause a
spiritual crisis. You may begin to question your own beliefs and values and ask
yourself why war or disasters happen. If this happens to you, talk to a family
member, friend, or spiritual advisor. Consider spiritual study, prayer, or
meditation.

Negative coping skills

Negative coping skills are certain ways you may try to
deal with your symptoms and problems that cause more harm than good. These are
quick fixes that don't improve your situation in the long run. They include
drinking too much, avoiding others, and lashing out.

Support groups and social support

There are times
when you may need a shoulder to cry on or a ride to the doctor. You may want to
learn more about PTSD or talk with others who have PTSD. You need people who
understand what you are going through and will help you and care about you.
This is your support network.

Support takes many
forms. You can find it in seminars and groups led by professionals, in groups
made up of others with PTSD, and in your relationships with family and friends.

Family and Community

Post-traumatic stress disorder (PTSD) can harm your relationships with your family and
community. Feelings of anger and depression and not wanting to deal with people
can make it hard to connect with them. Pay attention to how you act with your
family and try not to pull away. Your relationships can make a big difference
in your recovery from PTSD.

Here are things you can do to help
yourself, your family, and your community better understand and deal with PTSD.

Know when to get crisis help. Sometimes
you need help right away. This may be the case when you have had thoughts about
suicide or if anger turns to rage.

Help your family.
Your family plays an important part in your recovery from PTSD. But you also
have to help them. This means:

Talking to your family about PTSD and what
it does to you.

Talking to your kids. Be sure they know they aren't
to blame.

Talking about your triggers. Triggers are places, sounds,
and sights that can cause symptoms. They can be locations, social events, or
holidays.

Know that life transitions, even
positive ones such as getting married, having a baby, or starting a new job,
can cause stress and result in more PTSD symptoms.

Your family and community are part of your recovery. Do
as much as you can to work with them. With this knowledge, your family and
community can better help you.

Other Places To Get Help

Organizations

Anxiety Disorders Association of America
(ADAA)

8730 Georgia Avenue

Suite 600

Silver Spring, MD 20910

Phone:

(240) 485-1001

Fax:

(240) 485-1035

Web Address:

www.adaa.org

The Anxiety Disorders Association of America (ADAA)
works to improve the lives of people who have anxiety disorders. Members of the
association are not only people who have or are interested in anxiety disorders
but also health professionals who do research and treat people who have anxiety
disorders.

International Society for Traumatic Stress Studies
(ISTSS)

111 Deer Lake Road

Suite 100

Deerfield, IL 60015

Phone:

(847) 480-9028

Fax:

(847) 480-9282

Email:

istss@istss.org

Web Address:

www.istss.org

The International Society for Traumatic Stress Studies
(ISTSS) is an international forum for sharing research, clinical strategies,
and public policy concerns on traumatic stress. The Society offers newsletters
and other publications, conferences, and links from its Web site to other
organizations that have the same interests.

National Alliance on Mental Illness
(NAMI)

3803 North Fairfax Drive

Suite 100

Arlington, VA 22203

Phone:

1-800-950-NAMI (1-800-950-6264) hotline for help with depression(703) 524-7600

Fax:

(703) 524-9094

Email:

info@nami.org

Web Address:

www.nami.org

The National Alliance on Mental Illness is a national
self-help and family advocacy organization dedicated solely to improving the
lives of people who have severe mental illnesses such as schizophrenia, bipolar
disorder (manic depression), major depression, obsessive-compulsive disorder,
and panic disorder. NAMI focuses on support, education, advocacy, and research.
The mission of the organization is to "eradicate mental illness and improve the
quality of life of those affected by these diseases."

National Center for Posttraumatic Stress
Disorder

Veterans Administration Medical Center (116D)

215 North Main Street

White River Junction, VT 05009

Phone:

(802) 296-6300

Email:

ncptsd@va.gov

Web Address:

www.ptsd.va.gov

The National Center for PTSD carries out a wide range of
activities, including research, education, and training to help understand,
diagnose, and treat PTSD in veterans. The website has fact sheets and videos
to answer questions on trauma, PTSD, and related issues.

National Institute of Mental Health
(NIMH)

6001 Executive Boulevard

Bethesda, MD 20892-9663

Phone:

1-866-615-6464 toll-free

Phone:

(301) 443-4513

Fax:

(301) 443-4279

Web Address:

www.nimh.nih.gov

The National Institute of Mental Health (NIMH) provides
information to help people better understand mental health, mental disorders,
and behavioral problems. NIMH does not provide referrals to mental health
professionals or treatment for mental health problems.

National Suicide Prevention Lifeline

Phone:

1-800-273-TALK (1-800-273-8255)

TDD:

1-800-799-4TTY (1-800-799-4889)

Web Address:

www.suicidepreventionlifeline.org

The National Suicide Prevention Lifeline is a 24-hour,
toll-free suicide prevention service. Crisis centers are located in 130
locations across the United States. Each caller is routed to the closest provider
of mental health and suicide prevention services.

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use.